Diabetes mellitus

Oral health effects

• Periodontitis (more severe, faster progressing)

  Poorly controlled diabetes is a well-established risk factor for periodontitis, with greater attachment and bone loss. The relationship is bidirectional: periodontitis also worsens glycemic control.

  Mechanism: Hyperglycemia drives an exaggerated inflammatory response, advanced glycation end-products (AGEs), impaired neutrophil function, and poor wound healing.

  Clinical management: Coordinate periodontal therapy with glycemic management; assess HbA1c, reinforce control, and use more frequent maintenance.

• Dry mouth and increased tooth decay (xerostomia)

  Reduced salivary flow and higher glucose levels raise caries and candidiasis risk.

  Clinical management: Caries prevention, fluoride, salivary support, candidiasis monitoring.

• Slower healing and higher infection risk

  Delayed wound healing and greater susceptibility to oral infection.

  Clinical management: Atraumatic technique; consider antibiotic need on a case basis.

• Denture sore mouth and thrush (denture stomatitis / oral candidiasis)

  Denture wearers with diabetes are about twice as likely to develop Candida-associated denture stomatitis (red, inflamed palate under the denture); thrush is also more likely with poor glycemic control and dry mouth.

  Clinical management: Examine tissue under removable prostheses at every visit; reinforce nightly denture removal and daily denture cleaning/soaking; refer for antifungal therapy when present and check fit; ask about glycemic control (HbA1c).

• White lacy patches or sores on the cheeks/tongue (oral lichen planus)

  Oral lichen planus is moderately more common in adults with diabetes (pooled OR about 1.9). It appears as white lacy streaks, red patches or erosions, most often on the buccal mucosa.

  Clinical management: Document and photograph lesions; refer erosive or non-resolving lesions for oral medicine evaluation/biopsy; use gentle technique and non-irritating (SLS-free, alcohol-free) products; consider undiagnosed diabetes screening when OLP is found.